Saturday 14 December 2019

'All life is brought into our therapy rooms in its raw beauty and difficulty'

Robin Williams and Matt Damon in Good Will Hunting
Robin Williams and Matt Damon in Good Will Hunting

Psychotherapy has many definitions but, in ­essence, it is the encounter between two, or more, people to talk about what matters. It is a search for understanding of self and others. Often, it is about how life might be different in people's inner emotional lives and relationships, how to understand the past in order to go differently into the future; what life is like and how to change it.

Psychotherapy is a response to inner yearning and the practical necessity for direction. The range of therapy models, each taking different approaches, are united by the simple, researched fact that it is the relationship between therapist and client that is the most significant and crucial factor in therapy.

The style of therapy - Systemic Family Therapy, Humanistic and Integrative, Constructivist, Psychoanalytic, Cognitive-Behavioural, Dialectical Behaviour, Mindfulness, Acceptance and Commitment and all other therapeutic modalities across the spectrum - are secondary to that. What is essential is that therapists are trained, formally affiliated, professionally registered, for example, with the Psychological Society of Ireland, the Family Therapy Association of Ireland or their own professional bodies, and with The Irish Council for Psychotherapy, which is the umbrella organisation for the registration of psychotherapists in Ireland

There is no doubt that there is an ­increase in people seeking therapy since it was first tentatively introduced into Ireland in the 1940s.

Many would say a new generation of young men and women have simply become comfortable with therapy - the queue for college counselling being one indication that this is so.

Others believe that with the demise of religion's healing rituals, people are seeking re-enactment of confession and forgiveness in new, dynamic forms so that they can change themselves, change other people or change their lives.

For, if psychotherapy is about anything, it is about change; changes in perception, in relationships, in roles, in expectations, in patterns of communication, in feeling, in internal dialogue, in adjusting to life-cycle stages, in coping with workplace issues, redundancy and retirement and in making practical decisions that have to be made.

Psychotherapy facilitates changes in thinking, acting and being. That is why, in this complex world, more and more people seek therapy, because they know that it is a sign of mental health to examine their lives. When times are tough, therapy can be a source of support.

All life is brought into the therapy room in its raw beauty and difficulty; good and evil, promises, disappointments, past, future, meaning, futility, addiction and liberty, envy and admiration, guilt and acceptance, parental and family relationships, attachment and loss. Therapy is where people explore marital bonds, broken promises, betrayal, abuse, chronic illness, disability, anxiety and fear, regret and remorse and the pain of depression. At the core of the psychotherapy encounter is the hope that in conversation with a person, who is trained to listen, interpret, facilitate and advise, that life will get better by taking a new approach or letting go of an old one.

And so it is. People come to therapy with all kinds of ideas about what therapy will entail and media images are surprisingly influential. Research shows that there are more than 1,000 films depicting psychotherapy, many of which (just think of Prince of Tides for example) are so removed from reality, with breaches of ethics, boundaries and treatment, that it is no wonder there is confusion about how therapy actually works. Woody Allen's depictions send their own tragic humour about what he describes as "priests, shamans and now shrinks" involving themselves in other people's business, and yet there are some moments in films, such as the old classic Ordinary People or scenes in Goodwill Hunting, that get to the heart of how talking can help to clarify what can be retrieved from disaster by letting go of what cannot be and looking ahead to what is possible.

Therapy is much more mundane than media depictions, and the first session usually begins with discussion of what brings the person to seek psychotherapy at this time, their expectations of therapy and hopes about what it may achieve. Information is given by the therapist about what therapy entails. At the end of the session, therapist and client decide on what further appointments, if any, are to be made, because each person has different needs in terms of number, frequency and duration of sessions. Men and women both seek therapy; men often being more focused on practical strategies, stress management and decision making; women often showing more interest in emotions and relationships. But in ­essence, the quests are similar - it is just the words and styles of communicating that are different.

For the therapist, the experience is not without its human element and most therapists never lose their consciousness of the privilege and responsibility, the solemnity and duty when another person trusts you with their fears, their hopes, their emotions, their decisions and the secrets of their life. That is what makes psychotherapy such a startlingly wonderful profession. How people speak about what matters to them can be extraordinarily beautiful, courageous and inspirational. The mystery of the human condition is not our frailty but our strength and search for meaning. And therapists are "suffering humans too", as psychiatrist Sebastian Kramer of the Tavistock Centre in London points out, but with the advantage of being trained to think and talk about mental pain, a lifetime of experience of doing so and skills to make sense of it all so that no story is new and few dilemmas are unfamiliar.

The late famous psychologist Miller Mair once said about therapy, and I agree, that "you have to listen to the lilt and rhythm, to the use of words and phrases, the telling metaphor, the silence, and the moving spaces in between". It is indeed often in the "not said", the catch of breath, the glance, the pause, the silence that we learn.

Dr Marie Murray is a Registered Clinical Psychologist and Psychotherapist and author @drmariemurray

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